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Multivessel Spontaneous Coronary Artery Dissection With Coronary Artery Fibromuscular Dysplasia

Franz Schweis1, Ara H Rostomian1, Derek Phan1

  • 1Department of Cardiology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California, USA.

CJC Open
|May 26, 2021
PubMed

Insights

This case study shows fibromuscular dysplasia (FMD) can affect coronary arteries, leading to spontaneous coronary artery dissection. Extra-coronary imaging is crucial for diagnosing FMD in such cases.

Area of Science:

  • Cardiology
  • Vascular Medicine
  • Radiology

Background:

  • Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome.
  • Fibromuscular dysplasia (FMD) is a non-atherosclerotic vascular disease often affecting renal and carotid arteries.
  • The association between FMD and SCAD is increasingly recognized.

Observation:

  • A 53-year-old woman presented with acute coronary syndrome.
  • Coronary angiography revealed SCAD in multiple coronary arteries.
  • Associated FMD was diagnosed in the vertebral and renal arteries.

Findings:

  • Follow-up coronary angiography demonstrated a "string of beads" appearance in the posterior descending artery, characteristic of FMD.
  • This suggests FMD can manifest angiographically within the coronary arteries.
  • The case underscores the importance of considering FMD in patients with SCAD.

Implications:

  • Highlights the necessity of screening for FMD in patients with SCAD, even without typical FMD risk factors.
  • Suggests that coronary artery imaging may reveal characteristic FMD findings.
  • Emphasizes the role of comprehensive vascular imaging in managing complex cardiovascular presentations.

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